Drugs & Aging

, Volume 33, Issue 3, pp 169–177 | Cite as

Evolution of Clinical Pharmacy in the USA and Future Directions for Patient Care

  • Barry L. CarterEmail author
Review Article


This paper describes key events in pharmaceutical education, training, practice, and research that have occurred over the past 55 years. Some of these events included the development of the doctor of pharmacy degree, residency training, and co-location of clinical pharmacists in patient care areas. These changes not only necessitated more specialized training but then led to board certification to ensure quality patient care. Specific examples of the research that have supported the involvement of clinical pharmacists in direct patient care will be discussed.


Residency Training Clinical Pharmacy Clinical Pharmacist Drug Information Direct Patient Care 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



This article was written as a contribution to the Special Issue on Clinical Pharmacy that was developed following my presentation at the 42nd Annual Symposium of the ESCP in Prague, the Czech Republic, in October 16–18, 2013.

Compliance with Ethical Standards


The author is supported by the National Heart, Lung, and Blood Institute (RO1HL091841 and R01HL091843).


  1. 1.
    McLeod DC, Miller WA. The practice of pharmacy: institutional and ambulatory pharmaceutical services. Cincinnati: Harvey Whitney Books; 1981.Google Scholar
  2. 2.
    Elenbaas RM, Worthen DB. Clinical pharmacy in the United States: transformation of a profession. Lenexa: American College of Clinical Pharmacy; 2009.Google Scholar
  3. 3.
    Buttaro M. AACP house of delegates vote: colleges to move to sole entry-level Pharm.D. Am J Hosp Pharm. 1992;49:2346–50.PubMedGoogle Scholar
  4. 4.
    American Council for Pharmacy Education. Standards revision 2016. Accessed 16 Dec 2015.
  5. 5.
    McLeod DC. Pharmacy residency and fellowship training programs. In: McLeod DC, Miller WA, editors. The practice of pharmacy: institutional and ambulatory pharmaceutical services. Cincinnati: Harvey Whitney Books; 1981. p. 482–97.Google Scholar
  6. 6.
    Cardoni AA, Jackson EA. Drug information services. In: McLeod DC, Miller WA, editors. The practice of pharmacy: institutional and ambulatory pharmaceutical services. Cincinnati: Harvey Whitney Books; 1981. p. 94–113.Google Scholar
  7. 7.
    Black HJ, Tester WW. Pharmacy operation utilizing unit dose concept. Am J Hosp Pharm. 1964;21:343–50.Google Scholar
  8. 8.
    Smith WE, de Leon RF, Herfindal ET, Hirschmann JL, Miller RA. The Ninth-Floor Pharmacy Project at the University of California, San Francisco: a seminal development in clinical pharmacy. Am J Health Syst Pharm. 2015;72:2108–13.CrossRefPubMedGoogle Scholar
  9. 9.
    Carter BL, Elliott WJ. The role of pharmacists in the detection, management, and control of hypertension: a national call to action. Pharmacotherapy. 2000;20:119–22.CrossRefPubMedGoogle Scholar
  10. 10.
    Carter BL, Helling DK. Ambulatory care pharmacy services: the incomplete agenda. Ann Pharmacother. 1992;26:701–8.PubMedGoogle Scholar
  11. 11.
    Carter BL, Helling DK. Ambulatory care pharmacy services: has the agenda changed? Ann Pharmacother. 2000;34:772–87.CrossRefPubMedGoogle Scholar
  12. 12.
    Love DW, McWhinney BD. Ambulatory clinical practice programs. In: McLeod DC, Miller WA, editors. The practice of pharmacy: institutional and ambulatory pharmaceutical services. Cincinnati: Harvey Whitney Books; 1981. p. 202–15.Google Scholar
  13. 13.
    Carter BL, Helling DK, Jones ME, Moessner H, Waterbury CA Jr. Evaluation of family physician prescribing: influence of the clinical pharmacist. Drug Intell Clin Pharm. 1984;18:817–21.PubMedGoogle Scholar
  14. 14.
    McKenney JM, Slining JM, Henderson HR, Devins D, Barr M. The effect of clinical pharmacy services on patients with essential hypertension. Circulation. 1973;48:1104–11.CrossRefPubMedGoogle Scholar
  15. 15.
    Monson R, Bond CA, Schuna A. Role of the clinical pharmacist in improving drug therapy: clinical pharmacists in outpatient therapy. Arch Intern Med. 1981;141:1441–4.CrossRefPubMedGoogle Scholar
  16. 16.
    Juhl RP, Perry PJ, Norwood GJ, Martin LR. The family practitioner-clinical pharmacist group practice: a model clinic. Drug Intell Clin Pharm. 1974;8:572–5.Google Scholar
  17. 17.
    Perry PJ, Hurley SC. Activities of the clinical pharmacist practicing in the office of a family practitioner. Drug Intell Clin Pharm. 1975;9:129–33.PubMedGoogle Scholar
  18. 18.
    Helling DK, Hepler CD, Jones ME. Effect of direct clinical pharmaceutical services on patients’ perceptions of health care quality. Am J Hosp Pharm. 1979;36:325–9.PubMedGoogle Scholar
  19. 19.
    Helling DK. Family practice pharmacy service: part I. Drug Intell Clin Pharm. 1981;15:971–7.PubMedGoogle Scholar
  20. 20.
    Helling DK. Family practice pharmacy service: part II. Drug Intell Clin Pharm. 1982;16:35–48.PubMedGoogle Scholar
  21. 21.
    Reinders TP, Steinke WE. Pharmacist management of anticoagulant therapy in ambulant patients. Am J Hosp Pharm. 1979;36:645–8.PubMedGoogle Scholar
  22. 22.
    McKenney JM, Witherspoon JM, Pierpaoli PG. Initial experiences with a pharmacy clinic in a hospital-based group medical practice. Am J Hosp Pharm. 1981;38:1154–8.PubMedGoogle Scholar
  23. 23.
    Scrivens JJ Jr, Magalian P, Crozier GA. Cost-effective clinical pharmacy services in a veterans administration drop-in clinic. Am J Hosp Pharm. 1983;40:1952–3.PubMedGoogle Scholar
  24. 24.
    Directions for clinical practice in pharmacy. Proceedings of an invitational conference conducted by the ASHP Research and Education Foundation and the American Society of Hospital Pharmacists. February 10–13, 1985. Am J Hosp Pharm. 1985;42:1287–1292.Google Scholar
  25. 25.
    Acquisto NM, Hays DP. Emergency medicine pharmacy: still a new clinical frontier. Am J Health Syst Pharm. 2015;72:2092–6.CrossRefPubMedGoogle Scholar
  26. 26.
    Shank BR, Schwartz RN, Fortner C, Finley RS. Advances in oncology pharmacy practice. Am J Health Syst Pharm. 2015;72:2098–100.CrossRefPubMedGoogle Scholar
  27. 27.
    Carmichael JM, Hall DL. Evolution of ambulatory care pharmacy practice in the past 50 years. Am J Health Syst Pharm. 2015;72:2087–91.CrossRefPubMedGoogle Scholar
  28. 28.
    Benedict N, Hess MM. History and future of critical care pharmacy practice. Am J Health Syst Pharm. 2015;72:2101–5.CrossRefPubMedGoogle Scholar
  29. 29.
    Hepler CD. Unresolved issues in the future of pharmacy. Am J Hosp Pharm. 1988;45:1071–81.PubMedGoogle Scholar
  30. 30.
    Hepler CD, Strand LM. Opportunities and responsibilities in pharmaceutical care. Am J Hosp Pharm. 1990;47:533–43.PubMedGoogle Scholar
  31. 31.
    Levy G, Tsuchiya T. Salicylate accumulation kinetics in man. N Engl J Med. 1972;287:430–2.CrossRefPubMedGoogle Scholar
  32. 32.
    DeVane CL. Parents and mentors may be gone but they are never forgotten. Pharmacotherapy. 2015;35:1–3.CrossRefPubMedGoogle Scholar
  33. 33.
    Jelliffe RW, Brooker G. A nomogram for digoxin therapy. Am J Med. 1974;57:63–8.CrossRefPubMedGoogle Scholar
  34. 34.
    Hull JH, Sarubbi FA Jr. Gentamicin serum concentrations: pharmacokinetic predictions. Ann Intern Med. 1976;85:183–9.CrossRefPubMedGoogle Scholar
  35. 35.
    Carter BL, Bosworth HB, Green BB. The hypertension team: the role of the pharmacist, nurse, and teamwork in hypertension therapy. J Clin Hypertens (Greenwich). 2012;14:51–65.CrossRefPubMedCentralGoogle Scholar
  36. 36.
    Carter BL, Ardery G, Dawson JD, et al. Physician and pharmacist collaboration to improve blood pressure control. Arch Intern Med. 2009;169:1996–2002.CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Borenstein JE, Graber G, Saltiel E, et al. Physician-pharmacist comanagement of hypertension: a randomized, comparative trial. Pharmacotherapy. 2003;23:209–16.CrossRefPubMedGoogle Scholar
  38. 38.
    Chisholm-Burns MA, Kim Lee J, Spivey CA, et al. US pharmacists’ effect as team members on patient care: systematic review and meta-analyses. Med Care. 2010;48:923–33.CrossRefPubMedGoogle Scholar
  39. 39.
    Hammond RW, Schwartz AH, Campbell MJ, et al. Collaborative drug therapy management by pharmacists: 2003. Pharmacotherapy. 2003;23:1210–25.CrossRefPubMedGoogle Scholar
  40. 40.
    Malone DC, Carter BL, Billups SJ, et al. An economic analysis of a randomized, controlled, multicenter study of clinical pharmacist interventions for high-risk veterans: the IMPROVE study: Impact of Managed Pharmaceutical Care Resource Utilization and Outcomes in Veterans Affairs Medical Centers. Pharmacotherapy. 2000;20:1149–58.CrossRefPubMedGoogle Scholar
  41. 41.
    Carter BL, Coffey CS, Ardery G, et al. Cluster-randomized trial of a physician/pharmacist collaborative model to improve blood pressure control. Circ Cardiovasc Qual Outcomes. 2015;8:235–43.CrossRefPubMedPubMedCentralGoogle Scholar
  42. 42.
    Carter BL, Bergus GR, Dawson JD, et al. A cluster randomized trial to evaluate physician/pharmacist collaboration to improve blood pressure control. J Clin Hypertens (Greenwich). 2008;10:260–71.CrossRefPubMedCentralGoogle Scholar
  43. 43.
    Carter BL, Foppe van Mil JW. Comparative effectiveness research: evaluating pharmacist interventions and strategies to improve medication adherence. Am J Hypertens. 2010;23:949–955.Google Scholar
  44. 44.
    Carter BL. Designing quality health services research: why comparative effectiveness studies are needed and why pharmacists should be involved. Pharmacotherapy. 2010;30:751–7.CrossRefPubMedGoogle Scholar
  45. 45.
    Weber CA, Ernst ME, Sezate GS, Zheng S, Carter BL. Pharmacist-physician comanagement of hypertension and reduction in 24-hour ambulatory blood pressures. Arch Intern Med. 2010;170:1634–9.CrossRefPubMedPubMedCentralGoogle Scholar
  46. 46.
    Chen Z, Ernst ME, Ardery G, Xu Y, Carter BL. Physician-pharmacist co-management and 24-hour blood pressure control. J Clin Hypertens (Greenwich). 2013;15:337–43.CrossRefPubMedCentralGoogle Scholar
  47. 47.
    Von Muenster SJ, Carter BL, Weber CA, et al. Description of pharmacist interventions during physician-pharmacist co-management of hypertension. Pharm World Sci. 2008;30:128–35.CrossRefGoogle Scholar
  48. 48.
    Svarstad BL, Kotchen JM, Shireman TI, et al. Improving refill adherence and hypertension control in black patients: Wisconsin TEAM trial. J Am Pharm Assoc. 2013;53:520–9.CrossRefGoogle Scholar
  49. 49.
    Carter BL, Clarke W, Ardery G, et al. A cluster-randomized effectiveness trial of a physician-pharmacist collaborative model to improve blood pressure control. Circ Cardiovasc Qual Outcomes. 2010;3:418–23.CrossRefPubMedPubMedCentralGoogle Scholar
  50. 50.
    Carter BL, Coffey CS, Uribe L, et al. Similar blood pressure values across racial and economic groups: baseline data from a group randomized clinical trial. J Clin Hypertens (Greenwich). 2013;15:404–12.CrossRefPubMedCentralGoogle Scholar
  51. 51.
    Dickerson LM, Kraus C, Kuo GM, et al. Formation of a primary care pharmacist practice-based research network. Am J Health Syst Pharm. 2007;64:2044–9.CrossRefPubMedGoogle Scholar
  52. 52.
    Maddux MS. Board of Regents commentary. Qualifications of pharmacists who provide direct patient care: perspectives on the need for residency training and board certification. Pharmacotherapy. 2013;33:888–91.CrossRefPubMedGoogle Scholar
  53. 53.
    Council on Credentialing in Pharmacy. Scope of contemporary pharmacy practice: roles, responsibilities, and functions of pharmacists and pharmacy technicians. Accessed 2 April 2014.
  54. 54.
    Murphy JE, Nappi JM, Bosso JA, et al. American College of Clinical Pharmacy’s vision of the future: postgraduate pharmacy residency training as a prerequisite for direct patient care practice. Pharmacotherapy. 2006;26:722–33.CrossRefPubMedGoogle Scholar
  55. 55.
    Saseen JJ, Grady SE, Hansen LB, et al. Future clinical pharmacy practitioners should be board-certified specialists. Pharmacotherapy. 2006;26:1816–25.CrossRefPubMedGoogle Scholar
  56. 56.
    Heath and Human Services. The Affordable Care Act is working. Accessed 16 Dec 2015.
  57. 57.
    Bodenheimer TS, Smith MD. Primary care: proposed solutions to the physician shortage without training more physicians. Health Aff (Millwood). 2013;32:1881–6.CrossRefPubMedGoogle Scholar
  58. 58.
    Smith M, Bates DW, Bodenheimer TS. Pharmacists belong in accountable care organizations and integrated care teams. Health Aff (Millwood). 2013;32:1963–70.CrossRefPubMedGoogle Scholar
  59. 59.
    Centers for Medicare and Medicaid Services. Accessed 16 Dec 2015.
  60. 60.
    Berenson RA, Hammons T, Gans DN, et al. A house is not a home: keeping patients at the center of practice redesign. Health Aff (Millwood). 2008;27:1219–30.CrossRefPubMedGoogle Scholar
  61. 61.
    Rosenthal TC. Advancing medical homes: evidence-based literature review to inform health policy. Accessed 22 Jan 2016.
  62. 62.
    Kellerman R, Kirk L. Principles of the patient-centered medical home. Am Fam Physician. 2007;76:774–5.PubMedGoogle Scholar
  63. 63.
    Rosenthal TC. The medical home: growing evidence to support a new approach to primary care. J Am Board Fam Med. 2008;21:427–40.CrossRefPubMedGoogle Scholar
  64. 64.
    National Committee for Quality Assurance. Patient centered medical home (PCMH 2014) standards. Accessed 1 Dec 2015.
  65. 65.
    Grumbach K, Bodenheimer T. Can health care teams improve primary care practice? JAMA. 2004;291:1246–51.CrossRefPubMedGoogle Scholar
  66. 66.
    Shaw KM, Handler J, Wall HK, Kanter MH. Improving blood pressure control in a large multiethnic California population through changes in health care delivery, 2004–2012. Prev Chronic Dis. 2014;11:E191.CrossRefPubMedPubMedCentralGoogle Scholar
  67. 67.
    Reid RJ, Coleman K, Johnson EA, et al. The group health medical home at year two: cost savings, higher patient satisfaction, and less burnout for providers. Health Aff (Millwood). 2010;29:835–43.CrossRefPubMedGoogle Scholar
  68. 68.
    Reid RJ, Fishman PA, Yu O, et al. Patient-centered medical home demonstration: a prospective, quasi-experimental, before and after evaluation. Am J Manag Care. 2009;15:e71–87.PubMedGoogle Scholar
  69. 69.
    Merenich JA, Olson KL, Delate T, Rasmussen J, Helling DK, Ward DG. Mortality reduction benefits of a comprehensive cardiac care program for patients with occlusive coronary artery disease. Pharmacotherapy. 2007;27:1370–8.CrossRefPubMedGoogle Scholar
  70. 70.
    Smith M, Bates DW, Bodenheimer T, Cleary PD. Why pharmacists belong in the medical home. Health Aff (Millwood). 2010;29:906–13.CrossRefPubMedGoogle Scholar
  71. 71.
    Board of Pharmaceutical Specialties. 2014 annual report. Accessed 16 Dec 2015.

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Department of Pharmacy Practice and Science, Room 527, College of PharmacyUniversity of IowaIowa CityUSA
  2. 2.Department of Family Medicine, Roy J. and Lucille A. Carver College of MedicineUniversity of IowaIowa CityUSA

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